Kentucky Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Kentucky Grantee: Kentucky Department of Insurance

Award Date: October 31, 2016

Total Award: $873,652

Baseline Award: $476,998

Selected Market Reforms Amount: $240,000

Workload Award Amount: $156,654

• Section 2713- The Kentucky Department of Insurance will conduct examinations to review preventive care claims and will potentially review other claim types as well. In conjunction with these examinations, the Department of Insurance will review issues revealed in consumer complaint data and in other resources. Should consumer complaint data indicate a specific problem area, a market conduct examination will focus on that service. Health insurance issuers will also be asked to pull claims related to an ICD9/10/CPT code to measure compliance with Kentucky’s statute for proper/timely payment of claims, as well as for compliance with Federal regulations and guidelines.

• Section 2718- The Kentucky Department of Insurance will have financial examiners review health insurance issuers’ Medical Loss Ratio (MLR) data and rebates paid to consumers. Data from the examinations will be tracked to ensure compliance with MLR. Health insurance issuers will be required to submit a report outlining progress made toward the mandated MLR level, and must include a listing of payments made to consumers.